Transcript Slide 1

Mental Health and Wellbeing Strategy
Meeting Agenda
1.Introductions – Key Stakeholders
2.Strategy – Highlights and Key Issues
3.New Partnership Steering Group and
Governance Arrangements
4.Service User and Carer Involvement
5.Membership of Work Stream Implementation
Groups
6.Next Steps
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Mental Health and Wellbeing in Gloucestershire
CONTENTS
1.
2.
3.
4.
5.
6.
7.
Introduction
National policy context
Local strategic context
Local outcomes information
Local needs assessment
Vision, aims and gaps identified
Governance and Implementation Planning
Appendices
1
Organisations and individuals involved in the development
2
Service user views
3
References and key supporting documents
4
Examples of vulnerable people
5
Definition of ‘Recovery’
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1. Introduction
This document outlines Gloucestershire’s response to No Health without Mental Health and supports
the county’s Joint Health and Wellbeing Strategy – ‘Fit for the Future’ and ‘Your Health, Your Care’ by
focusing on plans to improve outcomes relating to the mental health and wellbeing of children, young
people and adults in the county.
It is an overarching strategy which has been developed with input from representatives of the statutory
and voluntary sector in Gloucestershire and incorporates views of users of mental health services and
their carers (Appendix 1). It has also been guided by the provisions of ‘No health without mental
health: implementation framework’ which provides recommended actions to bring about improvements
in mental health and wellbeing for individuals.
The purpose is to provide a set of high level Gloucestershire aims which;
- take account of work already in place
- identify gaps in planning and;
- sets out a governance framework for monitoring both the development of detailed implementation
plans where required and progress against them.
More detailed action plans or commissioning frameworks are in place for a number of areas or will be
developed lead by the relevant organisations where required. These will be mapped in the
development of the implementation plans.
This document focuses on the six national objectives to improve mental health outcomes for
individuals and the population as a whole.
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2. National Policy Context
‘No Health Without Mental Health’1 sets out six objectives for mental health and wellbeing:
1) More people will have good
mental health
More people of all ages and backgrounds will have better wellbeing and good mental
health.
Fewer people will develop mental health problems – by starting well, developing well,
working well, living well and aging well.
2) More people with mental health
problems will recover
More people who develop mental health problems will have a good quality of lifegreater ability to manage their own lives, stronger social relationships, a greater sense
of purpose, the skills they need for living and working, improved chances in education,
better employment rates and a suitable and stable place to live.
3) More people with mental health
problems will have good physical
health
Fewer people with mental health problems will die prematurely, and more people with
physical ill health will have better mental health.
4) More people will have a positive
experience of care and support
Care and support, wherever it takes place, should offer access to timely, evidencebased interventions and approaches that give people the greatest choice and control
over their own lives, in the least restrictive environment, and should ensure that peoples
human rights are protected
5) Fewer people will suffer
avoidable harm
People receiving care and support should have confidence that the services they use
are of the highest quality and at least as safe as any other public service.
6) Fewer people will experience
stigma and discrimination
Public understanding of mental health will improve and, as a result, negative attitudes
and behaviours to people with mental health problems will decrease.
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The ‘No Health without Mental Health: Implementation Framework’1 recommends evidence-based
actions for the NHS, other public services and employers.
The framework details how success will be measured and how future work on outcomes indicators
will be taken forward nationally. It proposes a mental health dashboard which will map the most
relevant indicators from the three main outcomes sets (health, social care and public health) to the
strategy.
The proposed national outcomes indicators are set out below:
(1) More people have better mental
health
(2) More people will recover
(3) Better physical health
1 Self-reported wellbeing
(PublicHealthOoutcomesFramework)
2 Rate of access to NHS mental health
services by 100,000 population (Mental
HealthMinimumDataSet)
3 Number of detained patients (MHMDS)
4 Ethnicity of detained patients (MHMDS)
5 First-time entrants into Youth Justice
System (PHOF)
6 School readiness (PHOF) Emotional
wellbeing of looked after children (PHOF,
Placeholder)
7 Child development at 2-2.5 years (PHOF,
Placeholder)
8 IAPT: Access rate (IAPT Programme)
9 Employment of people with
mental illness (NHS
OutcomesFramework)
10 People with mental illness or
disability in settled accommodation
(PHOF)
11 The proportion of people who
use services who have control over
their daily life
(AdultSocialCareOutcomesFramew
ork)
12 Improving Access to
Psychological Therapies Recovery
Rate (IAPT Programme)
13 Excess under 75 mortality rate
in adults with severe mental illness
(NHS OF & PHOF, Placeholder)
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(4) Positive experience of care and
support
(5) Fewer people suffer
avoidable harm
(6) Fewer people experience
stigma and discrimination
14 Patient experience of community
mental health services (NHS OF)
15 Overall satisfaction of people who use
services with their care and support
(ASCOF)
16 The proportion of people who use
services who say that those services have
made them feel safe and secure (ASCOF)
17 Proportion of people feeling supported
to manage their condition (NHS OF)
18 Indicator to be derived from a
Children’s Patient Experience
Questionnaire (NHS OF, Placeholder)
19 Safety incidents reported
(NHS OF)
20 Safety incidents involving
severe harm or death (NHS OF)
21 Hospital admissions as a
result of self harm (PHOF)
Suicide (PHOF)
22 Absence without leave of
detained patients (MHMDS)
23 National Attitudes to Mental
Health survey (Time to Change)
24 Press cuttings and broadcast
media analysis of stigma (Time to
Change)
25 National Viewpoint Survey –
discrimination experienced by
people with MH problems (Time to
Change)
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The ‘No Health without Mental Health: Implementation Framework’ also recommends evidence based
actions for the NHS:
Providers of mental health
services
Commissioners of mental health
services
Providers of acute and
community health services
Focus on improving equality –
access and outcomes.
Appoint a mental health lead at
senior level.
Ensure clinical and other staff are
able to spot the signs of mental ill
health (especially A&E).
Implement NICE’s quality standard
on service user experience in adult
mental health and the ‘You’re
Welcome’ standards for young
people.
Ensure needs of whole population,
including seldom-heard groups are
assessed and the right services
commissioned to meet those needs.
Protocols for sharing information
with carers.
Strengthen clinical practice, risk
management and continuity of care.
Use NICE quality standards and
guidance from the Joint
Commissioning Panel for Mental
Health.
Orient services around recovery.
Effective commissioning in key
areas of transition and early
intervention.
Improve the physical health and
wellbeing of people with mental
health problems.
Support greater choice, including
that of treatment and of providers
through AQP.
Improving mental health of people
with long term physical conditions.
Commission innovative service
models to help improve the mental
health of people with long term
physical conditions and medically
unexplained symptoms.
Develop liaison psychiatry services.
Support local work to prevent
suicide and manage self harm.
Primary care providers
Improving access to support
services, including peer support and
befriending organisations.
Improve the identification of people
at risk of developing mental health
problems.
Identify and treat co-morbid physical
and mental illness.
Increase access for groups with
known vulnerability to mental health
problems.
Good practice in care planning,
including transitions.
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And for other organisations and public bodies:
Health and Wellbeing Boards
Social Services
Children’s services
A robust JSNA ensuring mental
health needs are properly assessed.
Work alongside CCGs to remodel
existing support to focus on early
intervention, service integration,
personalisation and recovery.
Work alongside CCGs, schools and
wider children’s services to focus on
early intervention and integrated
support.
Encourage joint commissioning.
Better joining up of health, social
care and housing support.
Improve emotional support for
children on the edge of care, looked
after and adopted children.
Community groups and user led
organisations to feed into needs
assessment.
Ensuring the mental health needs of
older people are identified and acted
upon.
Consider a named Board member as
lead for mental health.
Healthwatch to ensure that people
who use mental health services are
recruited as part of their membership.
Crown prosecution service
Schools and colleges
Public health services
Ensure they are aware of the options
available to enable treatment for
offenders.
Support children and young peoples’
wellbeing.
Develop a clear plan for public
mental health. (Incorporating three
tier approach ; universal, targeted,
early intervention).
Provide access to targeted evidence
based interventions for children with
or at risk of developing emotional and
behavioural problems.
Health improvement efforts to include
the specific physical health needs of
people with mental health problems.
Tackling bullying.
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3. Local strategic context
Two key strategic documents have been developed in Gloucestershire, including elements specifically
relating to mental health and wellbeing:
Health and Wellbeing Strategy ‘Fit for the
Future’
•
•
Poorly performing (compared with LA family
comparators) indicators from the JSNA plotted
across life stages and used to identify four priority
areas. These are:
– Promote healthy lifestyles across the life
course
– Reduce long term conditions and premature
mortality
– Improve mental health and resilience
– Improve the socio-economic determinants of
health
These are intended to become the work programme
for the strategy over the next 20 years.
‘Your Health, Your Care’ Strategy
•
•
•
Recovery focussed approach
Support for mental health needs of people with long
term conditions
Integrated approach to address physical and mental
health needs
Strategic Initiatives:
1) Primary mental health care and IAPT pathway –
‘intermediate care team’ development
2) Recovery focussed care – ‘pop up ‘ recovery
colleges
3) Extending mental health liaison services
4) Housing and employment
In addition the Children and Young People’s Partnership Plan is in place with a focus on:
•Looked After Children (LAC) and care –leavers
•Children requiring safeguarding
•Children subject to the effects of Poverty
•Children living in challenging circumstances (Including those children, affected by, domestic abuse; young carers;
substance misuse; mental health issues; complex needs; those in chaotic families(CCC)
•Children and Young People with Learning difficulties and Disabilities/ Complex Needs (CYPwLDD)
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4. Local Mental Health outcomes information
A review of the Gloucestershire position against the proposed outcomes measures (measures are not
yet available for all indicators) in the Implementation Framework shows:
More people will have better mental health
•Subjective wellbeing (ONS 2012) better than national rates (Life satisfaction 7.54 vs. 7.4; Life worthwhile 7.74 vs. 7.66; Happy 7.3 vs. 7.28;
Anxious 2.95 vs. 3.15)
Access to NHS mental health services (MHMDS)- rate (2010/11) higher than national (3264/100000 vs. 2789)
Formal inpatient detention (MHMDS) - rate (2010/11) lower than national but similar to peers (36.8% vs. 40.9% vs. 37.9%)
IAPT access (IAPT Key Performance Indicators)- rates for Q2 and provisional Q3 of 2012/13 are showing some improvement compared to
England rates (Q2- 2.2% vs. 2.5% and Q3 – 2.6% vs. 2.4%)
First-time entrants into Youth Justice System (Child Health Profile 2012, ChiMat))- rate lower than national (1120/100,000 vs.
1160/100,000)
More people will recover
•People with mental illness/disability in settled accommodation – proportion of adults on CPA receiving secondary MH services in settled
accommodation (ASCOF 2011/12 Indicator 1H )is lower than national average - (38.6% vs. 54.6%)
Employment of people with mental illness – proportion of adults on CPA receiving secondary MH services in employment (ASCOF 2011/12
Indicator 1F) s lower than national average (7.8% vs. 8.9%)
IAPT recovery rate: (IAPT Key Performance Indicators): the rate for Q2 and provisional Q3 of 2012/13 are above England rate (Q2 – 50.7%
vs. 45.9%; Q3 – 52.7% vs. 44%)
Fewer people suffer avoidable harm
•Suicide rates (2008/10 pooled DSR/100,000)- Rates in the county (10.2) are similar to regional rate (8.9) but higher than national rate
(7.9)(especially in males) Rates in females are similar to regional and national rates. (NHS Information Centre)
Self Harm Admission rates – Hospital stay rates (APHO, 2012) are higher than national rates (244.6 vs. 212))The highest rates are in
adolescents and young adults, but there is an increasing trend for 30-34 and 35-39. Rates are strongly associated with deprivation with the
highest rates in Gloucester and Cheltenham (Public Health intelligence Unit).
Absence without leave of detained patients (Routine Quarterly MHMDS Report)– rate of absences in 2FT generally lower than England
average (Final Qtr. 4 2011/12 summary– 2.8% vs. 3%)
Fewer people experience stigma and discrimination
•Attitudes to Mental health survey- Gloucestershire residents hold more positive and supportive views on mental illness, have better
understanding and are better informed that experience nationally (2FT Survey, 2008)
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5. Local needs assessment
5.1 Mental Wellbeing
Available wellbeing measures (ONS subjective wellbeing and self-reported measure of people’s
overall health and wellbeing (NI 119)) suggest that Gloucestershire has a higher level of wellbeing
compared to the national average, but there are significant variations within the county.
5.2 Risk/protective factors for and determinants of mental health.
Generally the county does very well compared with the national experience, but Gloucester and
Cheltenham have relatively high rates of many of the risk factors for mental ill-health e.g. deprivation,
unemployment, substance misuse, low levels of physical activity, crime etc. Other factors do not follow
this trend e.g. Fuel Poverty which is high in FOD, Stroud and the Cotswolds, and LLI which is high in
FOD. Rate of young people who are NEET is highest in Cheltenham. Visit the JSNA for more details
at: http://jsna.gloucestershire.gov.uk/Programmes/public-health/Mentalhealth/Pages/Library.aspx
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5.3 Emotional Health and Wellbeing of Children and Young People
The most recent national survey of child mental health carried out in 2004 revealed the impact of mental health problems
in childhood, with 1 in 10 children between the ages of 5-16 years identified as having a clinically diagnosed mental
disorder.
Population studies suggest that there may be up to 4,480 children and young people aged 5-16 years in Gloucestershire
with Conduct Disorder, 3,634 with Emotional Disorders, 1,183 with Hyperactive Disorders and 1,099 with less common
disorders.
It is estimated (No Health without Mental Health) that 50% of lifetime mental health disorders are developed before the
age of 14 and this can have profound effects on the child, their family and wider society. A growing body of evidence is
showing that good parental mental health is significantly associated with good child development outcomes, particularly
social, behavioural and emotional development. The quality of the relationship between parents, the quality of care given
to a baby, and the attachment that develops between infants and their parents are significantly linked to children and
young people’s learning and educational attainment, social skills, self-efficacy and self-worth, behaviour, and mental and
physical health throughout childhood and later adult life.
Children and young people who are at an increased risk of developing mental health disorders include a number of those
that are more vulnerable, who are taking risky behaviours, have long term conditions and both physical and learning
disabilities.
Emotional Development in Younger Children – the Early Years Foundation Stage Profile gives a good indication of
emotional development in younger children The percentage of children in Gloucestershire achieving relevant scores was
higher than regional and national average scores. However there is considerable variation around the county.
Emotional Health and Wellbeing of Children and Young People Survey1 - Gloucestershire had a higher level of good
emotional health and wellbeing compared with regional and national rates .
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Bullying and feeling safe- bullying can be a cause of mental health disorders such as anxiety and depression, and
could lead to self-harm in extreme cases. The latest On Line Pupil Survey1 showed that the majority of pupils felt
safe at school. The trend regarding pupils’ experience of serious bullying differed between year groups. There was an
increase in the proportion of primary school pupils reporting serious bullying between 2006 and 2012 and a decrease
among secondary school pupils in the same period.
Pupils with a disability, young carers, those entitled to free school meals, pupils with special educational needs and
those from non ‘British-white’ backgrounds were found to be less likely to feel safe and more likely to have
experienced bullying or known of/experienced domestic abuse.
The majority of pupils had not thought about deliberately hurting/harming themselves. Several groups of pupils were
found to be at higher risk, however. They were those who had experienced bullying, carers, pupils with a disability or
special educational needs.
A review2 of the emotional health and wellbeing of children and young people in Gloucestershire in 2009 showed
that:
There are pockets of deprivation where the prevalence of emotional difficulties is expected to be higher than other
areas
There were some gaps in service provision There was a need for earlier intervention and access to services as well
as more focussed community care for those with complex and severe needs.
Some more vulnerable groups more prone to mental health difficulties such as Looked After Children, and children
with disabilities including learning disabilities had unmet needs
Mental health services for children and young people in Gloucestershire were redesigned and recommissioned in
2011 in response to identified needs.
1Online
2Tellus4
Pupil Survey 2012 Summary Report, Strategic Need Analysis Team, Gloucestershire County Council
survey, 2009/10 http://www.dcsf.gov.uk/rsgateway/DB/STR/d000908/OSF04_2010.pdf
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5.4 Mental Health Problems in Adults
Common Mental Health Disorders
Rates of anxiety and depression are high in the county with prevalence highest in Cheltenham and Gloucester:
Serious Mental Health Problems
As a county, our rates are lower than national averages, but specific wards in the county experience rates that are higher
than national ones (i.e. seven in Gloucester- Westgate, Barton and Tredworth, Matson and Robinswood, Moreland,
Kingsholm and Wotton, Grange, Podsmead; four in the FoD – Cinderford East, Cinderford West, Lydney East, Lydney
North;, two in Cheltenham – St. Mark’s, Pitville; , one each in Cotswold – Cirencester Watermoor and Stroud districts Central).
Dementia
The Dementia rate recorded on GP registers is higher in Gloucestershire than regional and national rates. Even with this, it
is known that less than half of older people predicted to have Dementia in Gloucestershire in 2011 were on GP registers
(3,485 vs. 8,395). Furthermore, the rate in Gloucestershire is set to rise at a higher rate than nationally over the next
decade or so.
More details can be found in the JSNA at http://jsna.gloucestershire.gov.uk/Programmes/publichealth/Mentalhealth/Pages/Library.aspx
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5.5 Use of Health/Mental Health Services
http://www.mhmdsonline.ic.nhs.uk/statistics/
Use of Outpatient and Community Mental health Services – measured as specified contacts as a proportion of all
contacts over the period 2006/7 to 2010/11:
Psychiatrist contacts which had been historically higher than peers is now similar to them
CPN contacts which were initially lower have increased in recent years and is now higher than peers
Contacts with Psychologists have historically been lower than peers but is now approaching peer experiences
Social worker contacts have been varied over the years when compared with peers, with this being lower in
2010/11
OT contacts have been consistently lower than peers
Physiotherapy contacts have been historically higher than peers but now similar to peers
Psychotherapy contacts which were lower than peers are now higher.
For people on Care Programme Approach, over the five year period 2006/7 to 2010/11, the use of various teams has
varied compared with peers. This is recorded as activity of specific teams as a proportion of total open cases at the end
of the year:
General adult psychiatry which was historically higher than peers has fallen below recently
Old Age psychiatry has been consistently higher than peers
Substance misuse has been consistently lower than peers
Crisis resolution has been consistently lower than peers
Assertive Outreach has been mainly higher than peers except for 2008/9
Early Intervention higher than peers
Formal detention rates are lower than national rates.
There is a great variation in prescriptions of antidepressants and anxiolytics within the county which is not related to
need. Gloucestershire has a higher rate of benzodiazepines prescriptions at primary care level compared to regional and
national rates.
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5.6 Stigma
Gloucestershire residents generally have a more positive and supportive view of mental illness, and are better
informed than the national experience. Females, younger people, married people and professionals were more likely
to have a positive attitude to mental health.
Fewer people than nationally felt there were sufficient existing services for people with mental illness.
Media that are most effective for influencing views locally are TV news, other TV programmes, national newspapers,
TV soaps and plays.
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6. Vision, aims and gaps identified
This section sets out the high level aims for Gloucestershire, mapped against the ‘No Health without
Mental Health’ objectives. The aims for each objective incorporate ‘gaps’ identified through the Steering
Group.
6.1 More people will have good mental health
Improving mental wellbeing of individuals, families and the general population – reducing the social and
other determinants of mental ill health across all ages. Starting well, developing well, working well,
living well and aging well.
In line with the Health and Wellbeing Strategy the vision for mental wellbeing takes a life course
approach.
We aim to:
• Improve the mental wellbeing of vulnerable children
• Provide more support for parents and families to ensure children get the best start in life
• School-based mental health promotion initiatives
• Promotion of work place mental health initiatives
• Promote good mental wellbeing for all, including the most vulnerable groups, through increasing
social connectivity by adopting an asset based approach to community building
• Affordable Warmth schemes
• Improve provision and take-up of welfare advice
• Improve access to psychological therapies throughout the life course
• Vulnerable* people - improve social networks/support for vulnerable groups including those in
rural areas.
• Strategic approach to volunteering in the county.
• Improve the population mental wellbeing through the promotion of the Five Ways to Wellbeing
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*see Appendix 4 for examples
Gloucestershire is committed to enabling everyone to have better mental health. Public Health are
developing a ‘Public Mental Health Plan’ that aims to work in partnership with the public, private and
voluntary sector to deliver a number of interventions that will improve people’s mental wellbeing and
prevent the incidence of mental ill health occurring.
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6.2 More people with mental health problems will recover
Tackling emerging and ongoing problems, as well as acute distress, to help people have a good
quality of life.
A shared understanding of the meaning of ‘recovery’ is defined in Appendix 5
•Within the context of the understanding of ‘recovery’, increase the number of people who recover
by:
•Improving opportunities for education, training and employment and support people to access
these
•Improving housing choices for people with mental health problems
•Improving access to services in rural areas e.g. transportation (or community based/provided
services)
•Provide effective support for carers (including young carers)
•Whole family support where a parent experiences mental ill-health. This is a vulnerable group
that frequently remain hidden from services.
•Services to be effective and ‘recovery’ oriented
•Improve the ‘recovery rates’ from treatment (clinical outcomes measures)
•Improve support for lifestyle choices and access to mainstream services
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Case study (Recovery)
Sarah is a 49 year old woman who has lived with a severe mental health condition for most of her life.
Sarah was connected with an Occupational Therapist who works within a third sector organisation that
specialises in supporting people with MH conditions to recover. Initially Sarah was agoraphobic,
lacked confidence and all activity was prescribed by others.
Sarah was supported to identify her own recovery goals that were important to her and to identify
steps that she could take to reach those goals. This process was client led rather than service led and
focussed on Sarah’s strengths and passions rather than taking the more traditional deficit approach.
Sarah is now able to travel independently, makes her own decisions, is independent in all activities
and regularly volunteers with a local organisation that requires excellent communication skills. Sarah is
able to identify some of the triggers that can make her ill and is able to manage these effectively.
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6.3 More people with mental health problems will have good physical health
Fewer people with mental health problems will die prematurely and more people with physical ill health
will have better mental health.
•Integrate care pathways across primary care, mental health, planned and unscheduled care services for
all long term conditions to reduce physical and mental co-morbidity and ensure a person is considered
holistically and as an individual (ensure patient experience is a key measure of the success of
integration)
•Improve access to psychological therapies for medically unexplained symptoms and long term
conditions
•Increase partnership work across statutory, voluntary and community and private sectors (employers) to
achieve aims around early detection and access to treatment.
•Improve access to specialist support and treatment and increase community based alternatives to
inpatient care
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Case study (People with mental health problems will have good physical health)
Stuart is a 55 year old man who has had a severe mental health condition throughout his life. He has
often managed his emotional issues through comfort eating and has become morbidly obese and is a
type 2 diabetic. Stuart was referred to a 6 week ‘Kitchen Challenge’ programme. The Kitchen
Challenge programme uses cooking as vehicle for communicating wider messages such as: team
work, improving confidence, daily organisational skills and being exposed to challenges that people
haven’t experienced before.
Participating in the Kitchen Challenge enabled Stuart to identify his skills and strengths and recognise
his potential. This led to an increased feeling of self worth and confidence which contributed to a
sense of improved wellbeing. He felt able to engage in health changing activities and has lost a
significant amount of weight, has well controlled diabetes and is physically active.
With an improved sense of wellbeing, Stuart was confident enough to work with his living companions
and challenge the way in which they ate within the supported housing environment. Supported by the
staff, Stuart led the change in how the house ordered, purchased, cooked and budgeted for their
meals based upon the healthy eating principles he had learnt during the kitchen challenge programme.
Meals are now chosen, cooked and eaten together.
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6.4 More people will have a positive experience of care and support
focusing on choice, control and personalisation; improved experience for children and young people
including during transition to adult services; promoting equality and reducing inequality
•Listen and learn from patient and carer experience and satisfaction monitoring and taking action to
improve the service experience
•Take action to ensure that choices and options in services are fully accessible and understood by
people according to their needs
•Increase the personalisation of care and services
•Improve the involvement of people experiencing mental ill health and carers (including young carers) in
the planning, delivery, monitoring and evaluation of services
•Ensure appropriate access to comprehensive advocacy services
•Improve transition from child to adult mental health services
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6.5 Fewer people will suffer avoidable harm
Fewer people suffering avoidable harm from the care and support they receive; fewer people
suffering avoidable harm from themselves; fewer people suffering harm from people with mental
health problems and improving safeguarding of adults, children and young people.
•Reduce suicide rates
•Working in partnership (for instance with planning authorities to reduce avoidable harm from
jumping from high places)
•Reduce self-harm incidents and admission rates
•Robust Safeguarding and Governance mechanisms across all health and social care
commissioned services
•Improve the reporting of and learning from serious incidents across all health and social care
services
•Improve the processes and understanding / mental health workforce training and development
around risk assessment (including the need for self management and positive risk taking)
•Training and support for the carers of and people who work with Looked After Children especially
related to children who have traumatic experiences, children and young people with disabilities and
challenging behaviour.
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Case study (Fewer people will suffer avoidable harm)
Fiona is a 28 year old lady who was referred to the ‘ASPIRE’ project by her GP. The ASPIRE project is designed to
support people who have a long term condition to gain key skills that will enhance their employability.
Fiona has a history of childhood and adulthood abuse and repeatedly self harms. She is keen to enter into work but is
worried that because she self harms regularly this will make it difficult to find a job. Fiona also faces a number of
socioeconomic barriers as a result of being in receipt of benefits that cause her anxiety levels to increase which has a
negative impact on her self harming. Staff supported Fiona to navigate her way through the numerous financial barriers
that she faced.
Fiona worked with the staff at the ASPIRE project to identify the specific issues in her life that led her to feel unhappy
and self harm. She was supported to access specialist help to address some of the issues whilst continuing to engage
with the ASPIRE project.
Working on a one to one basis and taking a strength based approach, the staff at ASPIRE enabled Fiona to identify
her skills, talents and passions rather than focussing on the negative issues in her life. Fiona is still working with the
staff at ASPIRE and receives specialist support from the mental health services, however she has learnt to manage
some of the triggers that have caused her to self harm in the past and has begun a volunteering job that has helped to
build her confidence and gain further skills.
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6.6 Fewer people will experience stigma and discrimination
Public understanding of mental health will improve and, as a result, negative attitudes and behaviours
to people with mental health problems will decrease.
•Positive action to influence attitudes towards mental ill health
•Enable all people to seek help when they need it without fear of stigma or discrimination
•Develop initiatives to reduce isolation and improve wellbeing in all our communities
•Support community development approaches
•Increase availability of individual employment support services
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Case study (Fewer people will experience stigma and discrimination)
Gloucestershire is committed to promoting the well being and social inclusion of all citizens with
mental health problems, their carers and families. Various interventions across all Health and
Social care services aim to enable people with mental health problems, their families and carers,
to live as full and equal citizens of their local communities, recognising their rights to
independence and self determination at the same time as respecting the rights of local
communities.
Mental Health First Aid is one such intervention and is being implemented across priority groups
within Gloucestershire with the aim of raising awareness of how to support someone with a
mental health problem with the expectation that increased knowledge leads to reduced levels of
misunderstanding and a reduction in stigma.
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7. Governance and implementation planning
The preceding sections set out high level actions across a broad range of objectives. It is important to
acknowledge that actions to deliver improvements in many of these areas are already in place in the
county. A key objective for the development of this strategy has been to align strategies which impact
on emotional health and wellbeing to set out a ‘joined up’ Gloucestershire approach.
This section sets out:
a)
b)
Proposed governance arrangements.
Summary of actions and objectives and routes for developing and/or reporting on implementation
plans
28
7a) Proposed governance arrangements
It is proposed to establish a Mental Health and Wellbeing Group reporting into the Health and
Wellbeing Board:
Gloucestershire
Health and
Wellbeing Board
Gloucestershire Mental Health and Wellbeing Group
Purpose
•Review and approve implementation plans.
•Receive reports from implementation leads and track progress.
•Ensure alignment of plans across organisational boundaries.
Proposed Membership:
Clinical Commissioning Group
Public Health
County Council
District Councils (Housing / Wellbeing)
Voluntary and Community Sector
Representative(s)
Mental Health Service User and Carer
representation
Service provider(s)
Criminal Justice
Employment
Education
Healthwatch
- Chair to be nominated by Health and Wellbeing
Board
- Terms of reference for Mental Health and
Wellbeing Group to be developed once basic
governance structure agreed.
- Group to meet quarterly
- Many of the work streams impacting on mental
health and wellbeing also relate to other areas of
wellbeing and it is not intended to create duplicate /
multiple reporting routes.
- Named senior leads to be nominated by the
relevant organisations and be responsible for
reporting back to their organisation
Underpinned by:
- Needs Assessment
- Views of service users and carers
- Equalities Act Requirements
Service user network
29
7b) Implementation planning
The development of an implementation plan which sets out all the different
organisations key actions and objectives and maps against any current
implementation forums is a vital next step in the process.
It is proposed that the establishment of a new Mental Health and Wellbeing
Group with representation from users and carers and membership from
across the range of public and voluntary sector organisations in the county
including Healthwatch lead on the implementation of the actions set out in
the national strategy and develop the implementation plan for the objectives
identified in this local strategy document.
It is proposed that this group develop a number of ‘action cards’ and track the
development of, and progress against these through the relevant
implementation groups and report back to the Health and Wellbeing Board
on the overall progress against plans.
30
Appendix 1
Organisations and individuals involved in development
Gloucestershire VCS Assembly supported a steering group with broad membership of the statutory
and voluntary sector:
Peter Steel - Independence Trust
Gillian Skinner - Gloucester City Council
Bren McInerney - Barton and Tredworth
Community Trust
Hannah Williams - NHS Gloucestershire
Di Billingham - NHS Gloucestershire
Helen Bown - NHS Gloucestershire
Eddie O’Neil- NHS Gloucestershire
Jane Melton - 2gether NHS Foundation Trust
Erica Smiter - People and Places in
Gloucestershire CIC
Karl Gluck -Gloucestershire County Council
Les Trewin - 2gether NHS Foundation Trust
Lorna Carter – Rethink Mental Illness
Mandy Bell - Gloucestershire Young Carers
Mark Branton - Gloucestershire County Council
Pete Carter - NHS Gloucestershire
Philip Booth -Guideposts Trust
Rachel Fisher - Carers Gloucestershire
Simon Bilous - Gloucestershire County
Council
Sophie Reed – Rethink Mental Illness
Steve O’Neil NHS Gloucestershire
Sue Cunningham - GL Communities
Trish Thomas - Survivors of Bereavement by
Suicide
Alex Dennison - Gloucestershire Probation
Trust
Corrine Cooper - Stonham
Jem Sweet - Scout Enterprises
Sola Aruna - Public Health
Tim Poole - Carers Gloucestershire
31
Sub groups were established to consider each of the national strategy objectives:
More people with good mental health
Hannah Williams – Lead
Sue Cunningham
Peter Steel
Karl Gluck
Mandy Bell
Increase recovery rates
Les Trewin - Lead
Peter Steel
Karl Gluck
Steve O’Neil
Physical health/mental health
Peter Steel – Lead
Erica Smiter
Helen Bown
Care and support
Karl Gluck – Lead
Erica Smiter
Rachel Fisher
Reduce people suffering avoidable harm
Sophie Reed - Lead
Trish Thomas
Sola Aruna
Reduce stigma/discrimination
Jane Melton – Lead
Gillian Skinner
Bren McInerney
32
Appendix 2
Views of mental health service users in Gloucestershire
‘Rethink’ were asked to consult with mental health service users across Gloucestershire. In
conjunction with Commissioners Rethink developed a series of simple questions based on the
overarching outcomes of the national strategy (No Health, without Mental Health). An overview of
the themes included in responses* is given below:
How can we ensure everyone has good mental
health?
Professional support
Mental Health promotion
Intervene early (childhood)
Talking therapies
Good housing
Education
Change at a societal level (Consumerist culture/media
images)
How can we help people with mental health
problems improve their physical health?
Better communication with GPs
Education on environment
Activities e.g. walking and gardening
Access to gyms/training e.g. gender specific classes,
support to access.
Medication e.g. issues related to long term use of
medication and side effects.
How can we help people recover from mental health
problems?
Attitudes/Interpersonal skills: Staff attitude towards illness and
recovery was not always helpful. Improve training.
Medication: Over reliance on medication as main treatment. Not
enough information on how long people are required to stay on the
medication and what the long term side –effects could be
Psychological Therapies: Increase availability and types of
therapy available.
Communication: Need for improved communication between
professionals.
Carers: Increased support for Carers.
Peer Support: Development of a range of peer support
(group/individual/expert by experience)
Occupation/Work/Activity: Improve access to facilities/services
that can support these areas
33
*It should be noted that the overall numbers of people that attended meetings, gave feedback via telephone/web survey are relatively small and
largely limited to individuals who use working age services.
How can we help people to have better experience of care?
How can we help people avoid harm?
Knowing what people are entitled to and how to access it (Rights)
Better support out of hours
Reduce fragmentation of services
Improved training for staff
Face to face contact
Regular contact
Social networks, friendship and structure
Intervene early
How can we reduce stigma and discrimination?
Education in schools
Work with employers (incl. NHS)
Use celebrities to promote positive mental health.
Mental Health radio station
Overarching Themes
Treatment and Psychological Therapies
Feedback indicated that people felt that there was still a reliance on medication and that other therapies were not always available in a
timely fashion.
Peer Support/ Expert Patients
Experts by experience programme could provide examples of positive role models to existing Service Users to aid recovery. More peer
groups as a means for Service Users to support each other.
Community Support
Helping people to develop support networks in their communities.
Education in Schools
This came across in response to a number of questions in relation to improving mental health, reducing stigma.
Employment
Improved access to work related activities as a means to improving mental health and aiding recovery.
34
Appendix 3
References and key supporting documents
No Health without Mental Health
No Health without Mental Health Implementation Plan
Gloucestershire ‘Fit for the Future’
Gloucestershire ‘Your Health Your Care’
Gloucestershire Children and Young Peoples Partnership Plan
Gloucestershire Children and Young Peoples Emotional Well Being Strategy
Report to NHS Gloucestershire and Gloucestershire County Council: An Overview of the use of Recovery, Social
Inclusion and Wellbeing approaches in the delivery of mental health services for people receiving long-term support”,
NTDI ,November 2010
Advocacy Strategy 2008-2011
Ageing Well in Gloucestershire (Draft)
Barnwood Trust – Unlocking Opportunities 2011 – 2021
Building Recovery in Communities
Carers Strategy 2007
Commissioning Framework for the Transition of Social Care 2010-15
Commissioning Framework for Transformation 2010-2015
Commissioning Talking Therapies for 2011-12
County Alcohol Strategy
Crime and Disorder Reduction Partnership Three Year Delivery Plan 2008-11.
Delivering Race Equality
Draft Transitions Protocol
Dual Diagnosis Strategy
Early Intervention and Prevention Strategy 2010-2013
35
Equality Schemes for statutory bodies
Extra Care Housing in Gloucestershire – a Strategy for the Future (2011
Fair Access to Care Services
Gloucestershire Drug Strategy Plan 2010-2013
Gloucestershire Carers and Young Carers Strategy
Gloucestershire Carers Multi Agency Strategy
Gloucestershire Child Death Review Process
Gloucestershire Child Protection Procedure
Gloucestershire Children and Young People’s Plan
Gloucestershire Health ad Social Care Community Prevention And Early Intervention Strategy 2010 – 2013
Gloucestershire Health and Wellbeing Strategy and action cards
Gloucestershire Homelessness Strategy 2008-11
Gloucestershire Hospital Carers Policy- developed from Gloucestershire Carers Strategy
Gloucestershire Housing and Support Strategy for Offenders 2011-2016
Gloucestershire Public Health Annual Report 2010/11
Gloucestershire Safeguarding Adults Policy and Procedure July 2011
Gloucestershire Self Directed Support (SDS) Operational Policy
Gloucestershire Social Inclusion Strategy
Gloucestershire Suicide Prevention Strategy 2011
Gloucestershire Supporting People Strategy 2011-2015
Gloucestershire’s Alcohol Harm Reduction Strategy 2010-13
Gloucestershire’s Multiagency Mental Health for Social Inclusion Strategy (launched 2009)
GSSJC Plan
Homeless and Housing strategy in Gloucester
Housing Strategy 2005 – 2010
Joint Commissioning Strategy for Older People 2007-2016
Joint Strategic Commissioning Plans 2010-13
36
Local Strategy for Employment of people recovering from Mental Illness
Market Management Strategy 2009-13
Maternal Depression Strategy 2005-2010
Mental Health and Social Inclusion Strategy for Gloucestershire
Mental Health commissioning strategy 2008-12
Preventing Suicide in Gloucestershire – A Strategy for Action 2006-10 (Gloucestershire Healthy Living
Partnership)
Prevention and Early Intervention Strategy 2010-13
Probation Accomodation Strategy
Promoting Children’s Mental Health within Early Years and School Settings
Safe and Confident Neighbourhoods Strategy: Next Steps in Neighbourhood Policing
Safeguarding Adults – Serious Case Review Policy
Self Directed Support operational Policy
Sexual health strategy
Shaping our futures 2009-2017- Gloucestershire strategy to support over 50s needs in terms of
Gloucestershire Sustainable Community Strategy
Smoke-free Gloucestershire Action Plan
Strategic framework for improving health in the south west
Strategies in development:
Strategy for maternal depression (2005 – 2010)
Stronger and Safer Communities Plan 2010-2013 Gloucester
Supporting People Strategy
Supporting People Strategy 2011-2015
Tackling Obesity Strategy 2007-17
The Bradley Report.
The Corston Report
The Dementia Strategy (revised 2009)
The Education of Children and Young People with Behavioural, Emotional and Social Difficulties as a Special
Educational Need paragraph 72
The Gloucestershire Integrated Economic Strategy 2009-15
Time to Change
Transport strategy
Tri-Nova Day Service Recommendations
37
Appendix 4
‘Vulnerable’ people refer to those who may be more likely to develop mental health problems. These include:
•
Children and young people experiencing poor parenting
•
Those who have suffered abuse and emotional neglect
•
Those in contact with the youth and adult criminal justice system
•
Children and young people underachieving in school
•
Looked after children
•
Early school leavers
•
Young LGBT
•
Homeless children and young people
•
Children and young people who have suffered four or more adverse childhood experiences
•
Young/Teenage mothers
•
Adults experiencing financial insecurities
•
Homeless adults
•
People misusing substances
•
People experiencing domestic violence and abuse
•
Adults experiencing civil emergencies e.g. floods
•
People experiencing violent crime
•
Adults out of work
•
Older people experiencing social isolation
•
People with long term physical health problems
•
People with caring roles
•
People living in residential care
•
People experiencing Fuel Poverty
38
Appendix 5
•
A shared understanding of the meaning of ‘recovery’
“Report to NHS Gloucestershire and Gloucestershire County Council: An Overview of the use of
Recovery, Social Inclusion and Wellbeing approaches in the delivery of mental health services for
people receiving long-term support”, NTDI ,November 2010
–
•
•
•
•
•
•
–
–
“Recovery embraces the following meanings:
A return to a state of wellness (e.g. following an episode of depression)
Achievement of a quality of life acceptable to the person (e.g. following an episode of
psychosis)
A process or period of recovering (e.g. following trauma)
A process of gaining or restoring something (e.g. one‟s sobriety)
An act of obtaining usable resources from apparently unusable sources (e.g. in prolonged
psychosis)
Recovering an optimum quality and satisfaction with life in disconnected circumstances (e.g.
dementia)
Recovery can therefore be defined as “a personal process of overcoming the negative
impact of diagnosed mental illness/distress despite its continued presence.”
Anthony Sheehan, then Director of Care Services, Department of Health (2004), Emerging
Best practice in Mental Health Recovery
39